Provider Demographics
NPI:1447973011
Name:WICKER, MARY CAPERS ELDER (PA)
Entity type:Individual
Prefix:
First Name:MARY CAPERS
Middle Name:ELDER
Last Name:WICKER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:CAPERS
Other - Last Name:ELDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:691 14TH ST NW UNIT 511
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-5620
Mailing Address - Country:US
Mailing Address - Phone:615-260-0199
Mailing Address - Fax:
Practice Address - Street 1:712 THOMAS GLEN CIR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37069-4013
Practice Address - Country:US
Practice Address - Phone:615-260-0199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-20
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant